Who Is at Risk for a Stroke?

A
stroke
occurs when an artery in the brain becomes blocked or a blood vessel carrying blood to the brain bursts. Either way, the brain does not receive enough blood and oxygen and brain cells begin to die.

Many of the risk factors for stroke can be lowered or treated. Others, such as increasing age, family history of stroke, your race, or prior stroke cannot be. The more risk factors you control, the more you can reduce your risk of having a stroke.

Developments in Prevention

Hypertension

Hypertension
is the most common and most preventable risk factor for stroke. Hypertension
is defined as having a systolic pressure greater than 140 mm Hg and diastolic pressure greater than 90 mm Hg. A good blood pressure is 120 mm Hg/80 mm Hg or lower. Blood pressure varies with age and normal values tend to increase with age. The American Heart Association recommends your blood pressure be measured on a regular basis starting at age 20. If you have normal blood pressure, you should get it checked at least once every two years or at every healthcare visit. If you have a certain condition, like diabetes, or repeated blood pressure readings that are elevated, your doctor may have stricter blood pressure goals for you. Reducing high blood pressure lowers your risk for stroke.

High Cholesterol

Lowering cholesterol levels with diet, exercise, and medication may help reduce the build-up of fatty arterial plaque (
atherosclerosis
) that can trigger a stroke. The American Heart Association recommends adults have a fasting cholesterol check at least once every five years starting at age 20. A desirable total cholesterol level is less than 200 mg/dL. If you have cardiovascular disease or diabetes, your doctor will have you follow stricter cholesterol guidelines and may check it more often.

Heart Arrhythmias

If you have
atrial fibrillation
(an irregular heart rhythm), a blood thinner such as warfarin may be able to lower your risk for stroke. Blood thinners help reduce blood clots from forming. Blood clots can block arteries that feed the brain, causing a stroke. However, your doctor should monitor your condition carefully if you are taking warfarin therapy to watch for possible bleeding.

Diabetes

If you have diabetes, keeping your blood in a specified target range can reduce your risk of stroke. Blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors can be helpful for this purpose.
Following your treatment plan to control your blood glucose level is also important in decreasing stroke risk.

Smoking

Smokers
have twice the risk of suffering a stroke as nonsmokers. This risk is increased even higher if you are also taking oral contraceptive pills. However, if you
stop smoking
, your risk of stroke will fall—within about five years—to the same level as someone who never smoked. There are many smoking cessation aids available today, including online support groups, nicotine patches, sprays, gum, or certain drugs.
Talk to your doctor if you need help to quit smoking.

Antiplatelet Medication

Antiplatelet medications make blood platelets less sticky and, therefore, less likely to form clots that can lead to strokes. Some people who have already suffered a stroke or a
transient ischemic attack
(TIA)
may benefit from taking an antiplatelet agent. Medications like
aspirin,
clopidogrel,
or the combination of aspirin plus
dipyridamol, may be prescribed.

Carotid Artery Surgery

If you have fatty arterial deposits in your neck, which can lead to stroke, you may benefit from
carotid artery surgery
. The carotid arteries supply the brain with oxygen. The surgery is done to restore blood flow. If you have severe arterial blockage and a history of previous stroke or TIA, this surgery may significantly reduce your risk of a second stroke.

Exercise

Exercising regularly
can reduce your risk of stroke. Work with your doctor to create an exercise routine that is safe for you.

Today we are much better prepared than in the past to prevent strokes. If you are at increased risk for stroke, discuss your options with your doctor. If you do experience symptoms of a stroke, it is important to immediately undergo medical evaluation. For acute strokes, the time to diagnosis and treatment is extremely important. If you think you are having a stroke, call for emergency medical services right away.

Furie KL, Kasner SE, et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association.
Stroke. 2010 October 21. Available at:
http://stroke.ahajournals.org/content/early/2010/10/21/STR.0b013e3181f7d043.full.pdf+html. Accessed March 26, 2014.

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